U.S. patent application number 10/108804 was filed with the patent office on 2003-01-16 for method for debriding bone, and bone debrided thereby.
Invention is credited to Ford, Louis, Jones, Alyce Linhurst, O'Leary, Robert K., Wolfinbarger, Lloyd JR..
Application Number | 20030014124 10/108804 |
Document ID | / |
Family ID | 26806292 |
Filed Date | 2003-01-16 |
United States Patent
Application |
20030014124 |
Kind Code |
A1 |
Wolfinbarger, Lloyd JR. ; et
al. |
January 16, 2003 |
Method for debriding bone, and bone debrided thereby
Abstract
The invention is directed to a method of debriding bone
including incubating the bone and associated soft tissue, with one
or more debriding solutions where the debriding solution may
include one or more alkaline solutions. Incubation is optionally
carried out with one or more debriding agents including inert dry
granular or particulate material including for example beads, and
the granular phase of an alkaline agent, including for example
granular sodium hydroxide. The incubating may be carried out with
agitation. In another embodiment, the medullary canal of the bone
is subjected to a positive pressure stream of debriding solution
under conditions sufficient to loosen the associated soft tissue
from the bone at the interface of the soft tissue and bone. In a
further embodiment, the debriding solution is provided as a
gel.
Inventors: |
Wolfinbarger, Lloyd JR.;
(US) ; O'Leary, Robert K.; (Deltaville, VA)
; Ford, Louis; (US) ; Jones, Alyce Linhurst;
(US) |
Correspondence
Address: |
LIFENET
5809 Ward Court
Virginia Beach
VA
23455
US
|
Family ID: |
26806292 |
Appl. No.: |
10/108804 |
Filed: |
March 27, 2002 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60279319 |
Mar 28, 2001 |
|
|
|
Current U.S.
Class: |
623/23.63 ;
510/137; 623/919; 8/94.11 |
Current CPC
Class: |
A61L 27/3608 20130101;
A61L 27/365 20130101; A61L 27/3691 20130101; A61F 2/4644 20130101;
A61L 27/3687 20130101 |
Class at
Publication: |
623/23.63 ;
8/94.11; 623/919; 510/137 |
International
Class: |
A61F 002/28; A61K
007/50 |
Claims
What is claimed is:
1. A process for debriding bone including soft tissue, comprising:
contacting said bone with one or more debriding solutions under
conditions sufficient to loosen said soft tissue from said bone to
produce a first processed bone; and removing said soft tissue from
said first processed bone to produce a debrided bone.
2. The process of claim 1, said debriding solution comprising one
or more alkaline solutions.
3. The process of claim 2, said alkaline solution comprising one or
more alkaline members selected from the group consisting of: sodium
hydroxide, potassium hydroxide, ammonium hydroxide, lithium
hydroxide, trisodium phosphate, tripotassioum phosphate and
triethanolamine.
4. The process of claim 1, said contacting, comprising: contacting
said bone with one or more gelled debriding solutions, said gelled
debriding solution comprising one or more alkaline solutions, under
conditions sufficient to loosen said soft tissue from said
bone.
5. The process of claim 3, said contacting, comprising: adding said
one or more alkaline members to said bone, where said one or more
alkaline members is dry, to form a dry mixture; adding water to
said dry mixture, said water in an amount sufficient to form an
alkaline solution at a concentration of from 5.0 to 25.0 M over an
incubation period, to form an alkaline mixture; incubating said
alkaline mixture for an incubation time of from 2 minutes to 20
minutes to form an incubated mixture; further adding water to said
incubated mixture in an amount sufficient to decrease concentration
of said incubated mixture to a concentration of from 0.1 to 5.0 M
to form a dilute alkaline solution, and second incubating said
dilute alkaline solution with said bone for a time period
sufficient to loosen said soft tissue.
6. The process of claim 1, said bone comprising a medullary canal,
and said contacting, comprising: subjecting said medullary canal of
said bone to a positive pressure stream of said debriding solution
under conditions sufficient to loosen said soft tissue from an
external surface of said bone.
7. The process of claim 6, said debriding solution comprising
sterile isotonic saline.
8. The process of claim 6, said debriding solution comprising
sterile water.
9. The process of claim 7, said positive pressure stream is at a
pressure of from 100 kPa to 1000 kPa.
10. The process of claim 8, said subjecting is carried out for a
period of time of from 10 minutes to 60 minutes.
11. The process of claim 1, said contacting comprising contacting
for a period of time of from 30 minutes to 18 hours.
12. The process of claim 1, said contacting comprising contacting
at a temperature of from 5.degree. C. to 65.degree. C.
13. The process of claim 3, said alkaline solution concentration is
from 0.1 N to 1.0 N.
14. The process of claim 3, said alkaline solution concentration is
from 0.1 M to 25.0 M.
15. The process of claim 14, said alkaline solution concentration
is from 0.5 M to 20.0 M.
16. The process of claim 14, said alkaline solution concentration
is from 0.5 M to 3.0 M.
17. The process of claim 1, said debriding solution further
comprising one or more permeation enhancers.
18. The process of claim 17, said permeation enhancer comprising a
surface-active agent.
19. The process of claim 1, said debriding solution further
comprising one or more inactivating agents.
20. The process of claim 19, said disinfectant is an alcohol.
21. The process of claim 1, said removing comprising: mechanically
removing said soft tissue from said bone using mechanical
means.
22. The process of claim 21, said mechanically removing comprising:
injecting air between said soft tissue and said bone; and
subjecting said bone and said soft tissue to a flow of aqueous
removal solution.
23. The process of claim 21, said mechanical means comprising a
scraper.
24. The process of claim 6, further comprising after said step of
subjecting, mechanically removing said soft tissue from said bone
using mechanical means.
25. The process of claim 24, said mechanical means comprising a pot
scrubber.
26. The process of any one of claims 1, 6, 21, or 22, wherein any
one or more or said steps of removing, mechanically removing,
injecting, and subjecting, is performed simultaneously or
sequentially.
27. The process of claim 22, said aqueous removal solution
comprises sterile endotoxin-free deionized/distilled water.
28. The process of claim 21, said mechanically removing,
comprising: scraping said first processed bone under a flow of
aqueous removal solution.
29. The process of claim 1, said one or more debriding solutions
comprise a gelled solution.
30. The process of claim 29, said gelled solution comprising one or
more members selected from the group consisting of a polymer and a
thixotropic agent.
31. The process of claim 30, said polymer comprising one or more
polymers selected from the group consisting of cellulose, methyl
cellulose and carboxy methyl cellulose.
32. A process for debriding bone including soft tissue, comprising:
contacting said bone including soft tissue with one or more
debriding agents under conditions sufficient to loosen said soft
tissue from said bone to produce a first processed bone; and
removing said soft tissue from said first processed bone to produce
a debrided bone.
33. A process for debriding bone including soft tissue, comprising:
contacting said bone including soft tissue with one or more
debriding agents and one or more debriding solutions, under
conditions sufficient to loosen said soft tissue from said bone to
produce a first processed bone; and removing said soft tissue from
said first processed bone to produce a debrided bone.
34. The process of any one of claims 1, 6, 32 or 33, said bone
comprising one or more members selected from the group consisting
of allogenic bone, autogenic bone and xenogenic bone.
35. The process of claim 34, said bone comprising allogenic
bone.
36. The process of claim 35, said allogenic bone is human cadaveric
bone.
37. The process of claim 36, said bone is frozen, thawed, or
partially thawed.
38. The process of any one of claims 32 or 33, said one or more
debriding agents comprise a granular alkaline agent.
39. The process of claim 38, said debriding agent further comprises
inert beads.
40. The process of claim 39, said beads comprising one or more
materials selected from the group consisting of an inorganic
material and an anorganic material.
41. The process of claim 40, said inorganic material comprises one
or more materials selected from the group consisting of glass,
ceramic, amorphous, metal, plastic, and crystalline.
42. The process of claim 38, said granular alkaline agent
comprising dry sodium hydroxide.
43. The process of any one of claims 1, 32, or 33, said contacting
comprising contacting in a closed container.
44. The process of claim 43, said closed container comprising a
rollable sealable bottle.
45. The process of claim 44, said rollable sealable bottle
comprising one or more materials selected from the group consisting
of glass and plastic.
46. The process of claim 43, said rollable sealable bottle
comprises baffles provided on an interior surface thereof.
47. The process of claim 39, said beads comprise one or more beads
of a size of from 0.01 mm to 100 mm in diameter.
48. The process of claim 47, said beads comprise one or more beads
of a size of from 0.1 mm to 10 mm in diameter.
49. The process of claim 32, said debriding agents further
comprising one or more debriding solutions.
50. The process of claim 49, said one or more debriding solutions
comprise one or more alkaline solutions.
51. The process of any one of claims 1, 6, 32, or 33, said
contacting is carried out from 30 minutes to 18 hours.
52. The process of any one of claims 32 or 33, further comprising
agitating said bone with said one or more debriding agents.
53. The process of claim 52, said agitating comprising rolling.
54. The process of claim 53, said rolling is performed at a rate of
from 10 to 100 revolutions per minute.
55. The process of claim 52, said debriding agent is present at a
volume sufficient to cover said bone during said agitation.
56. The process of any one of claims 1, 6, 32, or 33, further
comprising treating said debrided bone with a cleansing solution to
produce a cleansed bone.
57. The process of claim 56, said cleansing solution is at a pH of
from 4 to 7.
58. The process of claim 57, said cleansing solution comprising
N-lauroylsarcosinate.
59. The process of claim 58, said N-lauroylsarcosinate is at a
concentration sufficient to inactivate one or more of bacterial,
viral, microbial, fungal and prion contamination.
60. The process of claim 58, said N-lauroylsarcosinate is at a
concentration of from 0.001 mM and 100 mM.
61. Debrided bone produced by the process as claimed in any one of
claims 1, 6, 32, or 33.
62. Debrided bone produced by the process as claimed in claim
60.
63. The debrided bone of claim 61 substantially free from
bacterial, fungal, viral, microbial, and prion contamination.
64. The debrided bone of claim 62 substantially free from
bacterial, fungal, viral, microbial, and prion contamination.
65. The process of claim 10, said subjecting is carried out for a
period of time of from 10 minutes to 60 minutes.
66. The process of claim 65, said sterile isotonic saline exits
said bone at an interface of said bone and said soft tissue, where
said soft tissue is loosened from said bone to produce a first
debrided bone; and removing loosened soft tissue from said first
debrided bone to produce debrided bone.
67. The process of claim 66, said step of removing comprising
subjecting said first debrided bone to a stream of removal
solution.
Description
FIELD OF THE INVENTION
[0001] The invention relates to a process for efficiently removing
soft tissue from bone to produce debrided bone for use in the
production of clinical bone grafts. The soft tissue to be removed
is primarily periosteum, a specialized connective tissue covering
all of the bones of the body, muscle and connective tissue other
than periosteum, as well as cartilage on the articulating ends of
bones.
BACKGROUND OF THE INVENTION
[0002] Bone tissue is used in a wide variety of clinical
applications to repair and/or replace defective or damaged bones.
The bone used in these applications include whole or entire bones,
sections of bones, and/or ground bone including bone chips. Such
clinical applications include spinal fusions procedures,
craniotomies, and repair of compound fractures of long bones.
Demineralized cortico-cancellous bone chips and finely ground
demineralized bone powders are used as fill materials where there
is a bone defect, for example, in the repair of "holes" resulting
from surgical procedures where removal of parts of a bone or bones
or teeth.
[0003] Bone harvested from a cadaver is stored frozen until release
criteria, for example microbiological/virological testing, are
satisfied. At such time, the bone is thawed, debrided of excess
soft tissues on the surface of the bone, bone marrow is removed
from the cancellous bone space, and the bone is then cut into
clinically usable grafts. As a preliminary step in the preparation
of small bone grafts, soft tissues must be removed from the
exterior surface of the bone in order to permit assessment of the
"quality" of the bone. Bone from individual donors may not be
suitable for the production of specific types of bone grafts,
specifically load-bearing grafts such as the iliac crest wedge, and
by visually inspecting the debrided bone it is possible to assess
whether or not the bone will be suitable in the preparation of
small bone grafts. Thus, removal of external soft issues such as
the periosteum is important in the processing of bone into small
bone grafts.
[0004] Prior art methods for removing soft tissue from bone include
mechanically removing soft tissue and by enzymatic digestion. These
methods are disadvantageous in that they are labor intensive,
expensive, and also in the case of enzymatic digestion, may
introduce the potential of contamination of the processed bone with
immunogenic foreign proteins (the proteolytic enzymes) and/or
associated potentially infectious agents associated with the
extraction of the enzymes from animal species which might harbor
infectious agents.
[0005] The invention overcomes the problems presented by the prior
art methods by providing a simple and convenient method of
debridement. The method also provides the additional advantage of
inactivating infectious agents which may be associated with the
bone tissue being processed, such infectious agents including
bacteria, fungi, virus particles, and prions.
SUMMARY OF THE INVENTION
[0006] It is an object of the invention to provide a process for
debriding bone by contacting the bone with a debriding solution,
such debriding solution including one or more alkaline solutions,
to loosen the soft tissue including periosteum and other associated
soft tissues from the bone, thus facilitating the removal of such
soft tissue from the bone. Such contacting may include incubating
the bone with the debriding solution in a closed system. For
example, the bone and solution may be incubated in a roller bottle.
Another object of the invention is contacting the bone with a
debriding solution and one or more debriding agents. Such
incubation with a debriding agent may be simultaneous or
sequential. Suitable debriding agents include for example, beads
which beads are composed of, one or more of glass, ceramic, metal,
plastic, polymer, and composites. The debriding agent may be any
particulate matter sufficient to loosen and/or remove soft tissue
from bone and includes for example, screws, set screws, ground
glass, broken curved glass, dry alkaline chemicals used to form the
debriding solution, for example dry NaOH.
[0007] It is an object of the invention to provide a process for
debriding bone by subjecting the medullary canal of the bone to a
positive pressure stream of debriding solution.
[0008] It is a further object of the invention to provide a process
for debriding bone where the bone and debriding agent and/or
debriding solution, are agitated. Suitable methods of agitating
include agitating on a shaker table, revolving or rotating, for
example the bone and solution/agent are placed in a roller bottle,
and the roller bottle is rotated on a roller table, sonicating,
centrifuging, and subjecting the bone and solution and/or agent to
a pressure mediated stream of solution.
[0009] It is another object of the invention to provide a debriding
solution including one or more permeation agents which facilitate
permeation of the alkaline chemicals into the soft tissue and
includes for example, one or more surfactants and detergents.
[0010] It is a further object of the invention to provide a
debriding solution including one or more inactivating agents, such
inactivating agents including one or more antibiotics,
antimicrobials, antiviral agents, antifungals, and disinfectants,
to inactivate any potential biological contaminants present in the
tissue being processed.
[0011] It is an object of the invention to provide a process for
debriding bone including removing the loosened soft tissue from the
bone. Such removal includes for example, scraping the bone with
mechanical means and/or wiping the bone, such mechanical means
including for example a sterile brush, a household pot-scrubber,
and a scraper. Such removal may optionally be performed with a
removal liquid, such removal liquid may be provided as a stream,
for example a low, medium or high velocity stream. Suitable removal
liquids include water, the water optionally including one or more
inactivating agents including for example one or more
disinfectants, surfactants, detergents, and/or antibiotics.
[0012] A further object of the invention is to provide a process
for the debridement of cadaveric human bone, and bone from nonhuman
sources, having its periosteum ant other associated soft tissues
intact which includes contacting the bone with one or more
debriding solutions under conditions sufficient to loosen the
periosteum and other soft tissues from the external surfaces of the
bone, and thereafter removing the loosened soft tissue from the
bone using for example, one or more mechanical means.
[0013] Another object of the invention is to provide a process for
the debridement of cadaveric human bone, and bone from nonhuman
sources, having its periosteum and other associated soft tissues
intact which includes contacting the bone with one or more
debriding solutions for a period of time at a temperature
sufficient to loosen the periosteum and other soft tissues from the
external surfaces of the bone, and thereafter removing the loosened
soft tissue from the bone using for example one or more mechanical
means, such mechanical means including for example scraping,
scrubbing, wiping, and subjecting the external surfaces of the bone
to a stream of pressurized removal liquid including for example one
or more inactivating agents.
[0014] An object of the invention is to provide a process including
a debriding solution that is a gel.
[0015] Another object of the invention is to provide a process
where the gel is a reverse phase polymer.
[0016] A further object of the invention is to provide a process
where the reverse phase polymer is pluronic.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0017] I. Definitions
[0018] The below definitions serve to provide a clear and
consistent understanding of the specification and claims, including
the scope to be given such terms.
[0019] Alkaline Solution
[0020] By the term "Alkaline Solution" is intended a solution
including one or more of sodium hydroxide, potassium hydroxide,
ammonium hydroxide, lithium hydroxide, trisodium phosphate,
tripotassium phosphate and triethanolamine, preferably at a
concentration of from about 0.1 N to 1.0 N, or 0.1 M to about 25.0
M, more preferably at a concentration of from 0.1 M to 3.0 M.
[0021] Debriding Solution
[0022] By the term "debriding solution" is intended a liquid or gel
optionally including one or more alkaline solutions, suitable
debriding solutions including for example water, isotonic saline,
and aqueous solutions of one or more of sodium hydroxide, potassium
hydroxide, ammonium hydroxide, lithium hydroxide, trisodium
phosphate, tripotassium phosphate and triethanolamine.
[0023] Inactivating Agent
[0024] By the term "inactivating agent" is intended for the
purposes of the invention any agent that inactivates and/or kills
any viral, bacterial, or fungal contamination, and/or inactivates
prions. Suitable inactivating agents include for example one or
more of a surfactant, a detergent, an alcohol, listerine, an
antibiotic, an antiviral, and an antifungal. Preferred inactivating
agents include non-denaturing anionic surfactants including for
example n-lauroyl sarcosinate (NLS) and alcohols including for
example 1-octanol. A preferred inactivating agent is 1% NLS, 10%
1-octanol in 0.05 M sodium acetate buffer at pH 4.3-4.9.
[0025] Debriding Agent
[0026] By the term "debriding agent" is intended for the purposes
of the invention any solid matter of a shape and size sufficient to
loosen soft tissue from the surfaces of the bone to be debrided.
Suitable debriding agents include beads or particulate matter, for
example beads and/or particulate matter of uniform or non-uniform
size and/or shape, composed of for example, glass, metal, ceramic,
plastic, polymer, composites, and/or solid alkaline agent for
example NaOH. Suitable debriding agents include screws, set screws,
nuts, bolts, broken glass, ground glass, curved broken glass, round
beads, elliptical beads, biconcave beads, and faceted beads.
Preferably debriding agents include solid NaOH and biconcave
faceted beads, available from Hirschberg, Schutz & Co., where
the bead weighs 0.5 g and has sixteen faceted, sharp, slanted
surfaces, with a width of 7.7 mm and a height of 7.9 mm at a center
point. Preferably, the debriding agent includes particles having a
diameter of from about 0.1 to about 30 mm, preferably from about
1.0 to about 20 mm, more preferably from about 2.5 to about 15 mm,
and most preferably from about 5.0 to about 9.0 mm.
[0027] Substantially Free From
[0028] By the term "substantially free from" is intended a debrided
bone where any potential biological contaminants including for
example bacteria particles, virus particles, fungi, and prions, are
not detectable using detection mean known in the art at the time of
filing of this application.
[0029] Allowash.TM.
[0030] By the term "ALLOWASH.TM." solution is intended formulations
available from LifeNet, Virginia Beach, Va. and disclosed in U.S.
Pat. No. 5,820,581, and include solutions of
polyoxethylene-4-lauryl ether (Brij-35), octylphenol-ethylene oxide
(Nonidet P-40) and poly(ethylene glycol)p-nonyl-phenyl-ether
(Nonoxynol-9). A 1.times. solution of ALLOWASH.TM. contains about
0.66 wt % Brij-35, about 0.02 wt % Nonidet P-40, and about 0.02 wt
% Nonoxynol 9 in endotoxin free water.
[0031] Bone
[0032] By the term "bone" is intended for the purposes of the
invention, allogenic, autogenic, and xenogenic bone. Preferably,
the bone used is human cadaveric bone, and preferably includes the
femur, tibia, humerus, fibula, ulna, and radius.
[0033] Soft Tissue
[0034] By the term "soft tissue" is intended tissue normally
associated with bone including periosteum.
[0035] Permeation Agent
[0036] By the term "permeation agent" includes for the purposes of
the invention one or more agents capable of facilitating permeation
of the debriding solution into the soft tissue, and includes one or
more of a surfactant, a detergent, and a surface active agent.
[0037] Gel Forming Material
[0038] By the term "gel forming material" is intended any polymer
capable of gelling the desired debriding solution. Suitable
polymers include reverse phase polymers including for example,
pluronic. Suitable polymers include methyl cellulose and
carboxymethyl cellulose.
[0039] Debrided Bone
[0040] Bone debrided by the present process exhibits mechanical
properties substantially similar to those exhibited by non-debrided
bone, such mechanical properties including compressive strength,
tensile strength, deformability, plasticity, and machine
ability.
[0041] Agitation
[0042] By the term "agitation" is intended any method of increasing
contact between the bone to be debrided and the debriding solution,
and includes for example, shaking, for example using a shaker
table, subjecting the bone and soft tissue to a pressure mediated
stream of debriding solution, revolving the bone and debriding
solution, optionally in the presence of a debriding agent, for
example in a roller bottle on a roller table, at a rate of
preferably from about 10 to about 200 revolutions per minute, more
preferably from about 20 to about 100 revolutions per minute, and
more preferably at about 60 revolutions per minute, sonication, and
centrifugation.
[0043] II
[0044] Suitable debriding solutions include water, and alkaline
solutions and may optionally include one or more cleansing agents,
such cleansing agents including for example Allowash.TM. solution
as described in U.S. Pat. No. 5,556,379, other surfactants,
detergents, inactivating agents, permeation enhancers, surface
active agents, and one or more alcohols. Suitable cleansing agents
include one or more surfactants, detergents and permeation
enhancers, which cleansing agents are capable of facilitating
permeation of the soft tissues by the debriding solution. Suitable
alkaline solutions include, but are not limited to, sodium
hydroxide, lithium hydroxide, ammonium hydroxide, saturated lime
water, calcium hydroxide, trimethylammonium hydroxide, cupric or
cuprous hydroxide, potassium hydroxide, triethanolamine, and
tribasic phosphates such as K.sub.3PO.sub.4, Na.sub.3PO.sub.4, with
sodium hydroxide, potassium hydroxide and tribasic phosphates being
preferred.
[0045] The one or more debriding solutions including one or more
alkaline solutions are employed under conditions that promote
digestion of the organic components of soft tissues facilitating
debridement of the bone without altering the physical and chemical
characteristics of the underlying bone. Bone is composed of
hydroxyapatite, a "crystalline" phase of calcium phosphate, which
is insoluble at alkaline pH and is thus relatively inert to the
alkaline solutions used to debride the soft tissues from the bone.
For example, in the case of sodium hydroxide, the concentration of
the sodium hydroxide can vary between about 0.1N and about 5N,
preferably between about 0.5N and about 1N. The temperature can be
anywhere in the range of from about 5.degree. C. to about
65.degree. C., preferably from about 25.degree. C. to about
55.degree. C. for routine processing, and optimally from about
37.degree. C. to about 65.degree. C. or 2.degree. C. to about
10.degree. C. where preferred debridement times are shorter or
longer, respectively. The preferred temperature and concentration
of alkaline solution, vary depending on the desired time interval
used to loosen the soft tissue from the external surface of bone.
Based on processing schedules, bone can be treated at reduced
temperatures and alkaline solution concentrations overnight or at
elevated temperatures and high concentrations of alkaline solutions
for short periods of time, for example 30 minutes to 1 hour with 3N
NaOH at 55.degree. .C to 65.degree. C. in the morning prior to
initiation of the daily processing schedule, for example while the
bone is being thawed from the frozen state. The debriding solution
may optionally contain a variety of additives including
surfactants, detergents, inactivating agents, cleansing agents, and
gel-forming materials used to coat the bone.
[0046] Suitable contact times of the bone with the one or more
debriding solutions including one or more alkaline solutions, are
most preferably sufficient to loosen the attached soft tissues
without digesting the osteoid material in the bone, and preferably
for a period of time of from about 30 minutes to overnight. The
desired contact time can be varied, depending on the concentration
of alkaline solution and temperatures utilized to achieve the
desired processing time appropriate to production needs. For
example, if longer processing times are desired, the temperature
may be lowered and/or the concentration of alkaline solution can be
lowered, and/or incubation can be carried out without a debriding
agent or with a mild debriding agent including for example round
glass beads. Likewise, if shorter processing times are desired, the
temperature and concentration can be increased and/or incubation
can be carried out with a debriding agent, for example a sharp
edged bead. In addition, application of the debriding solution
including alkaline solution to specific areas of the bone can be
controlled by applying the solution in a viscous gel of an
appropriate biocompatible polymer including for example, pluronic,
methyl cellulose, or mixed copolymers of polyglycolic/polylatic
acid. Use of a debriding solution in a gel form facilitates
application of the debriding solution including one or more
alkaline solutions to those parts of the bone containing
significant quantities of soft tissue to be debrided with
restriction of application of the same solution to parts of the
bone lacking significant quantities of soft tissue. Specifically,
use of a reverse phase polymer including for example, pluronic
polymer in a range of from 5 to 20 wt % with the debriding solution
to provide a gelled debriding solution, has the additional
advantage of being a liquid at colder temperatures, for example the
temperature of a bone being thawed during early morning preparatory
activities, but a viscous gel at warmer temperatures, for examples
temperatures a bone might be held at following application of the
debriding solution including the alkaline pluronic polymer mixture.
For example, the alkaline pluronic polymer gel is "painted" onto
the bone at those locations where soft tissue removal is most
difficult to achieve or not applied where possible damage to the
underlying bone would be undesirable.
[0047] In another embodiment of the invention, sterile air is
injected under the periosteum, between the bone and the periosteum
to facilitate separation of the periosteum from the bone surface
prior to or in conjunction with mechanical debridement and to use a
stream of removal solution, for example water, over the bone during
the mechanical debridement following alkaline solution treatment in
that the stream of water flowing over the bone facilitates removal
of softened tissue and alkaline solutions. In general, alkaline
solutions impart a feeling of "slickness" when the fingers are
rubbed together or over treated tissues and thus absence of this
feeling of "slickness" can be used to determine when the alkaline
solution has been effectively removed from the debrided bone.
[0048] In accordance with a particular embodiment of the
debridement process described herein, alkaline solution penetration
can be enhanced by inclusion of a permeation enhancer. A permeation
enhancer can be included in the debriding solution optionally
including an alkaline solution to enhance accessibility of the
alkaline solution into more hydrophobic domains of the tissue, for
example lipid aggregates, and to facilitate solubilization and
removal of fragments and molecular species of the tissue broken up
or "dissolved" by the alkaline solution.
[0049] Suitable permeation enhancers include, but are not limited
to, surface active agents and detergents which may include
cationic, nonionic and anionic amphipathic or lipophilic agents;
brij-35, nonoxynol-9, nonidet P-40, sodium lauryl sulfate,
N-lauroylsarcosinate, dimthylsulfoxide, dimethyl formamide,
propylene glycol, benzyl alcohol, glycerol monolaurate, isopropyl
palmitate, isopropyl myristate, azacyclohexanes, lecithin,
dimethylacetamide, and detergents in the Tween and Triton series
and/or alcohols including isopropyl, ethanol, n-propyl and butyryl
alcohols. Preferred permeation enhancers are anionic amphipathic
detergents including for example sodium lauryl sulfate,
N-lauroylsarcosinate, and/or isopropyl alcohol and pluronic
polymer. The amount of permeation enhancer employed can vary
depending on the quantity of soft tissue to be debrided, with
suitable concentrations in the range of from about 3 mM to about 30
mM detergent and/or 70% alcohol in the debriding solution including
one or more alkaline solutions. Similar compositions, described in
Allowash.TM. technology, U.S. Pat. No. 5,556,379, and
N-lauroylsarcosinate at pH values between about 4 and 6 are
bactericidal and virucidal.
[0050] The alkaline/alcoholic solutions, may optionally contain one
or more other components beneficial to the process, for example one
or more inactivating agents, including for example one or more
antibiotics and/or disinfecting agents. Suitable antibiotics
include bacitracin, erythromycin, neomycin, tetracycline, polymyxin
B sulfate, vinocomycin, lincomycin, streptomycins, chloromycetin,
gentamicin, furosemide, immupenin, and penicillin's. Suitable
preferred disinfectants include those which are soluble in alkaline
aqueous solutions and are administered at concentrations known in
the art to be germicidal, and include, but are not limited to,
ethanol, isopropanol, 1-octanol, hydrogen peroxide (preferably as a
3% to 10% solution), cetyl alcohol, and benzalkonium chloride.
Disinfectants such as sodium hypochlorite should be avoided due to
the potential for gas emission in alkaline solutions. Preferably,
the disinfectant is isopropanol, 1-octanol, or ethanol, and are
employed at a concentration of from about 30 to about 70%, and
N-lauroylsarcosinate at a pH of from 4 to 6. Alcoholic
concentrations of 100% should be avoided due to a potential for
precipitation of proteins in the soft tissue making the soft tissue
more difficult to digest and debride from the bone. Optimum amounts
of other disinfectants, for example LISTERINE.RTM., can be readily
determined by one of ordinary skill in the art to which the present
invention pertains without undue experimentation.
[0051] III
[0052] A preferred embodiment of the invention includes contacting
the bone to be debrided in a closed system, for example a roller
bottle, with an amount of debriding agent sufficient to cover the
bone being processed. The debriding agent is preferably a
particulate solid material, more preferably a sharp edged
particulate material and/or a granular phase of the alkaline
solution, of a size and shape sufficient to loosen the associated
soft tissue from the bone and of sufficient size to be excluded
from the medullary canal of the bone during processing. Debriding
solution, preferably including one or more alkaline solutions, is
added to the bone and debriding agent in an amount sufficient to
cover the bone and debriding agent. The addition of debriding
solution may be prior to, simultaneous with or subsequent to the
addition of bone and debriding agent. The debriding agent
preferably includes a mixture of a granular phase of the alkaline
solution, for example solid, dry, NaOH. The bone including
debriding agent and debriding solution is then incubated under
conditions sufficient to loosen the soft tissue from the bone.
Incubation may optionally include agitation including for example
shaking, rotating, sonicating, centrifuging, and subjecting the
bone to a pressurized stream of solution. Rotating, for example,
can be carried out using a roller bottle which can be rotated on a
roller table, preferably at about 10 to about 100 revolutions per
minute, more preferably from about 20 to about 80 revolutions per
minute, and most preferably at about 60 revolutions per minute. The
roller bottle preferably includes means to ensure constant movement
of the debriding agent, and/or debriding solution, and bone, such
means including for example, baffles provided on the interior
surface of the roller bottle.
[0053] IV
[0054] An embodiment of the invention includes a pressurized
aqueous debridement solution delivery process. In this embodiment
the liquid or gaseous debridement solution is transferred from
within the medullary canal of the bone to the interface of the bone
and associated soft tissue. The debridement solution penetrates the
skeletal tissue by passing through the sharpey's fibres, haversian
canals, volkman canals and other foramen of the cortical bone. The
penetrating pressurized debridement solution exits as droplets or a
fine spray of solution under the attached soft tissues on the outer
surface of the undebrided bone. This process is preferably applied
to bones including a femur, tibia, humerus, fibula, ulna, and
radius. The transfer of the debriding solution is accomplished by
subjecting the medullary canal of the bone to a positive pressure
stream of the debriding solution. The debriding solution physically
lifts the soft tissue off the external surface of the bone, thus
loosening the adhering soft tissue from the bone. Depending on the
composition of the debriding solution, the debriding solution may
also chemically lift the soft tissue from the external surface of
the bone. Suitable debriding solutions for use in this method
include for example one or more of water and isotonic saline, at a
pressure of from about 100 kPa to about 1000 kPa, for a period of
time of from about 10 minutes to about 120 minutes, preferably from
about 15 minutes to about 60 minutes, and more preferably from
about 15 to about 30 minutes, preferably at ambient temperature.
The debridement solution may include one or more alkaline solutions
preferably including for example NaOH at a concentration of from
about 0.5 to about 5.0 M. The debriding solution may optionally
contain one or more of a surfactant, a permeation enhancer, an
inactivating agent, a proteolytic enzyme, an antibiotic, an
antiviral, and an antifungal. After the soft tissues have been
loosened using the pressurized process, the bone may then
optionally be subjected to incubation with one or more debriding
solutions and/or debriding agents. Thereafter, any remaining soft
tissue is removed. Preferably, this is accomplished by subjecting
the medullary canal of one end of the bone to a positive pressure
stream and closing the medullary canal at the other end of the
bone, thus causing the positive pressure stream to exit the bone at
the interface of the exterior surface of the bone and the
associated soft tissue, thereby loosening the soft tissue.
[0055] V
[0056] Another embodiment of the invention includes contacting the
bone with a debriding solution and debriding agents where the
debriding agents include one or more of a granular phase of an
alkaline agent and optionally one or more inert debriding agents,
preferably a sharp edged bead for example composed of polyallyl
diglycol carbonate polymer, glass, coarse sand, plastic, metal,
composite, and stainless steel. Preferably, a mixture of dry inert
debriding agent and dry alkaline granules are added to a closed
system, for example to a roller bottle, and the wet bone is added.
The wet bone, dry granules, inert debriding agent, and an amount of
water sufficient to produce a concentrated alkaline solution for
example, from about a 10.0 to about a 30.0 M solution, preferably
about a 20.0 M solution, and the system is then sealed and rotated
for example preferably at about 10 to about 100 revolutions per
minute, more preferably from about 20 to about 80 revolutions per
minute, and most preferably at about 60 revolutions per minute
until a temperature of about 35.degree. C. to about 45.degree. C.,
preferably about 40.degree. C. is achieved, for example for a time
period of from about 1.0 minutes to about 30 minutes, preferably
from about 2.0 minutes to about 20.0 minutes, and more preferably
for about 5.0 minutes. Thereafter, sterile water is added to the
bottle to dilute the alkaline solution to a desired molarity, for
example from about 0.5 to about 5.0 M, preferably diluted to about
2.0 M. The alkaline solution is then incubated with the bone for a
time period of from about 10 minutes to about 24 hours, preferably
from about 20 minutes to about 10 hours, and more preferably for
about 1 hour. The bone is then removed from the alkaline solution
and any remaining soft tissue is removed.
[0057] VI
[0058] An additional embodiment of the invention includes first
contacting the bone with a gelled debriding solution under
conditions sufficient to loosen the associated soft tissue from the
bone. The gelled solution is preferentially delivered to desired
areas of the surface of the bone being processed. For example,
gelled debriding solution is preferentially delivered to areas of
the bone having greater amounts of associated soft tissue. After,
the soft tissue is sufficiently loosened, the bone is processed
according to the invention. For example, thereafter any remaining
loosened soft tissue is removed mechanically and/or removed with
the use of a pressurized stream of removal liquid. Alternatively,
the bone may then be incubated with one or more debriding solutions
with or without one or more debriding agents. Thereafter, any
remaining associated soft tissue may be removed for example using
mechanical means or a pressurized stream of removal liquid.
[0059] The following examples are illustrative of the inventive
bone debridement process.
EXAMPLE 1
[0060] A whole left or right ilium, which has been harvested under
aseptic conditions in accordance with accepted practice and from
which excess associated soft tissues have been removed prior to
transport to the processing facility and frozen for storage until
proper release criteria have been satisfied, is thawed at least to
the point of thawing of externally associated soft tissue, for
example, the bone need not be thawed completely prior to initiation
of incubation with one or more debriding solutions including one or
more alkaline solutions. The bone to be debrided is placed into a
debriding solution including 1.0 N NaOH and Allowash.TM. solution
at a concentration of 0.01.times. at a volume adequate to cover the
bone. The temperature is maintained at 60.degree. C. for one to
three hours, or until the soft tissue is visibly softened. At this
time, the bone is removed from the debriding alkaline solution,
sterile air is injected between the periosteum and bone, and the
bone is placed under a stream of sterile slow flowing water and
mechanically debrided using a commercially available plastic "pot
scrubber". All processing is performed under aseptic conditions in
order to maintain sterility of the bone. Associated articular
cartilage is loosely associated with the underlying bone structure
and is then carefully removed in large pieces by mechanically
pulling from the bone and removed therefrom.
EXAMPLE 2
[0061] A whole left or right femur, which has been harvested under
aseptic conditions in accordance with accepted practice and from
which excess associated soft tissues have been removed prior to
transport to the processing facility and frozen for storage. When
proper release criteria have been satisfied, the tissue is thawed
prior to initiation of debridement. The bone to be debrided is
placed into a debriding solution including an alkaline solution of
0.5N NaOH containing N-lauroylsarcosinate at a concentration of
0.01 wt % and 30% v:v isopropanol, in a volume adequate to cover
the bone. The temperature is maintained at 10.degree. C. to
20.degree. C. for 12 to 18 hours, or until the soft tissue is
visibly softened. At this time, the bone is removed from the
debriding solution and placed into a roller bottle containing glass
bead having a diameter of from 1 to 4 mm, and N-lauroylsarcosinate
in an aqueous solution buffered to between pH 4 and 6, and
preferably at pH 5 to 5.6. The bone is rolled in the bottle at a
rate of 60 rpm until the associated soft tissue has been removed.
The bone is then removed and washed exhaustively to remove all
processing reagents and is then prepared for freeze-drying and/or
packaging in the hydrated state. All processing is performed under
aseptic conditions in order to maintain sterility of the bone.
Associated articular cartilage will be found to be loosely
associated with the underlying bone structure and may be carefully
removed in large pieces by mechanically pulling from the bone and
removed therefrom. Once the associated soft tissues have been
removed, the whole bone may be further processed using known art,
for example, as described in U.S. Pat. No. 5,556,379, to remove
associated bone marrow contained in the interior of the bone.
EXAMPLE 3
[0062] A whole left or right femur, which has been harvested under
aseptic conditions in accordance with accepted practice and from
which excess associated soft tissues have been removed prior to
transport to the processing facility and frozen for storage until
proper release criteria have been satisfied, is thawed prior to
initiation of debridement. The bone to be debrided is covered with
a debriding solution in the form of a gel, which is a viscous
alkaline solution of 0.5 N NaOH and Allowash.TM. solution at a
concentration of 0.01.times. and 30% v:v isopropanol, and one or
more gelling polymers including methylcellusolve and alginate, in a
volume adequate to cover the bone. The bone is then wrapped in a
commercially available plastic wrap to restrict water evaporation
and incubated in a humidified chamber at a temperature from
10.degree. C. to 20.degree. C. for from 3 to 18 hours, or until the
soft tissue visibly softened. At this time, the bone is removed
from the plastic wrappings and placed under a stream of slow
flowing water and mechanically debrided using a commercially
available plastic "pot scrubber". All processing is performed under
aseptic conditions in order to maintain sterility of the bone.
Associated articular cartilage is loosely associated with the
underlying bone structure and is carefully removed in large pieces
by mechanically pulling it from the bone. Thereafter, the bone may
be further processing using known methods, for example including
those described in U.S. Pat. No. 5,556,379, to remove associated
bone marrow contained in the interior of the bone.
EXAMPLE 4
[0063] A whole left or right femur, which has been harvested under
aseptic conditions in accordance with accepted practice and from
which excess associated soft tissues have been removed prior to
transport to the processing facility and frozen for storage until
proper release criteria have been satisfied, is thawed prior to
initiation of debridement. The bone is then covered with a gelled
debriding solution which is an alkaline solution consisting of 0.5
N NaOH and Allowash.TM. solution at a concentration of 0.01.times.
and 30% v:v isopropanol, and methylcellusolve or alginate, as the
gelling polymer, in an amount adequate to cover the bone. The bone
is then placed into a glass or plastic roller bottle and glass
beads in a size range of from 1 mm to 600 mm are added in an amount
sufficient to cover the bone. The bottle is closed and placed onto
a roller assembly and rolled at from 30 to 60 rpms, at a
temperature at from 10.degree. C. to 20.degree. C. for a period of
time of from 3 to 18 hours, or until the soft tissue is visibly
softened and removed. At this time, the bone was placed in a second
bottle and smaller glass beads in a size range of from 0.01 mm to 1
mm are added in an amount adequate to cover the bone, along with
antibiotics and 70% isopropanol, to affect a fine polishing of the
essentially debrided bone. Any soft tissue remaining is then
removed using a stream of slow flowing water and mechanically
debrided using a commercially available plastic "pot scrubber". All
processing is performed under aseptic conditions in order to
maintain sterility of the bone. Associated articular cartilage is
loosely associated with the underlying bone structure and is
carefully removed in large pieces by mechanically pulling it from
the bone. Thereafter, the bone may be further processing using
known methods, for example including those described in U.S. Pat.
No. 5,556,379, to remove associated bone marrow contained in the
interior of the bone.
[0064] Although the invention has been described with reference to
particular means, materials and embodiments, it is to be understood
that the invention is not limited to the particulars disclosed and
extends to all equivalents within the scope of the claims.
* * * * *